Social Dynamics Neglected in the Treatment of “Psychosis”
If we were to measure the success of the field of psychology in terms of its ability to help people with “psychosis” and improve the conditions in which they live, many might conclude that there has been a covert dark process against the message culture in years since Freud. The World Health Organization has records that suggest that recovery is more common in third world countries than in the U.S. were there is so much money spent on treatments, yet so little treatment available to the many who need it. Still, our psychologist are are often taught more about psychoanalytic theory than about the culture of “psychosis.” Additionally, there is evidence that, just as philosopher Michel Foucault predicted that incidents of Madness are on the rise in the modern world. The idea that social discourse can exclude and eventually alienate a person to the point of madness is a powerful one.
Indeed I have heard stories of people who start out homeless or in isolation in prison become permanently in “psychosis.” I myself let the corruption inherent in the politics of section 8 housing projects drive me into madness because I failed to accept the black market dynamics that dominate in our power structures. Indeed not fitting into a social discourse can be very limiting.
A Movement Divided by Research Generalization:
It is hard to be involved with promoting recovery from “psychosis” these days without coming across people in the movement who are against medication. Robert Whitaker’s book, Anatomy of an Epidemic popularly blames the well documented rise of madness on the use of medication. While misuse of medication, along with the medical paradigm is clearly an epidemic that needs to be addressed, I don’t think, and maybe Whitaker doesn’t either, that it alone is the cause of the rise of incidents of mental health issues in modern society.
Effective work with “psychosis” has been documented in research. There have been many self-directed, med free movements: moral treatment; psycho-social rehabilitation efforts at Sotoria House or I-ward; and the hospital-free houses initiated by Laing. So medication-free is possible for some!
Even though it is really bad that the mainstream AMA corruption and financial concerns block such efforts, I would like to argue that simply collecting research on their effectiveness does not capture the whole picture. There seems to be little thought given by research enthusiasts to realities of class or race-skimming in contrast to experiences of mass ghettoization that the majority of people who deal with “psychosis” must negotiate.
While med-free alternatives are certainly better than the hospital for many, I’d like to argue that recovery is more of a personal art than a scientific formula. Efforts that worked in the past generations, would need to factor in the immediate changes in culture and adjust to the region. Additionally, I would like to argue that with the level of homelessness and disparity in our current society, many of these efforts no longer exactly fit our needs.
I believe an anti-medication agenda, like many influenced by Whitaker may have, can happen when the focus of work is based on research. Just like the appalling pharmaceutical industry develops research by buying doctor’s documentation that simultaneously justifies their payment from insurance companies, med-free research fell short of proving that it worked for all individuals. Having some med-free alternatives makes sense for those who have been damaged by over-medication and for whom medication simply doesn’t work makes sense, but I’d argue that it is a generalization that everyone in society should take that direction.
The Reality of Mad Diversity
In short, psychological data can be used to make generalizations that can promote exclusion and alienation. This can divide the mad community. If Foucault is right and exclusion from discourse causes alienation that causes madness, requiring recovery figures to be medication free can hurt a lot of people who are stuck in perpetual traumatic circumstances. According to Whitaker’s research the haves will be bipolar and I have, at times, experienced feeling hated or dominated for daring to proclaim that I am self-proclaimed, have-not schizophrenia in survivor circles. I believe that message receivers need to learn not to generalize in treatment, that mad diversity can be learned. Sadly, mad people who are successful can easily promote their road to success with such passion, that they drown out other voices. Indeed the problem with the concept of relying on research to drive a problem-based mental health movement is that it leads inherently to generalization unless one can negotiate issues of culture effectively.
Socio-cultural Factors so Easily Missed by Mainstream Evidence-Based Practice
I believe that issues of social disparities, economic change, secret societies, corruption, the diminishing of spiritual insight, and other kinds of abuse play just as much a role in the phenomena as over-use of medication. If one is to examine my own personal story as laid out in my memoir, one might see how issues politics and corruption can play a role in mental subjugation and health issues. Even more powerful is my experience treating individuals in Oakland CA, some of whom are struggling to endure extreme states of deprivation, in terms of both basic needs and cultural capital. For many in urban board and care homes, medication is a non-issue, it is needed to endure. I have heard some real-life people in Oakland, claim to have endured more violence in street life than they did as soldiers in Viet Nam. And furthermore if one is to consider the work of Franz Fanon, just as a small example, one would see that I am not the only one who says social contexts matter. The early psychological anthropological of Nancy Scheper-Hughes looking at economics in Ireland also can work to reinforce such claims. Thus, all voices need to be lifted, not just that are disproportionately privileged.
And while it is a good thing evidence based practice efforts is now trying to bring about paradigm change to recovery, I see it merely a replication of an old, diseased process. As a result, I intend to look at the way psychological theory operates. I intend to look at the presumption that any theory universally can carry itself across cultural divides, epochs, and even locales. Perhaps mental health workers need to be more mindful of how universal theories get in the way of meeting a person where they are at. In the process I hope to point out the way “psychosis” has been woefully invisible in the process of theory. I think that concepts of universality of theory, mixed with social conflict and exploitation in “advanced” and powerful societies may have the effect of making things worse, not better, for the burgeoning lot of message receivers.